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Doctors at Kaiser Permanente in San Francisco have reported that two previously hepatitis C negative men who have sex with men have contracted the virus through sexual activity and while on PrEP. The news was reported in the Feb. 19 edition of Clinical Infectious Diseases.

AIDSMap reports the two men were part of a cohort of people receiving the HIV prevention drug through the health programs. There were 485 people who started the drug between February 2011 and December 2014.

Hep C hadn’t been thought as sexually transmitted. But the study that underscored that finding relied on heterosexual couples. Recent studies have found probable sexual transmission of the virus — which attacks the liver — in men who have sex with men in the U.S., Europe and Australia.

Doctors at Kaiser Permanente in San Francisco have reported that two
previously hepatitis C negative men who have sex with men have
contracted the virus through sexual activity and while on PrEP. The news
was reported in the Feb. 19 edition of Clinical Infectious Diseases.

AIDSMap reports the two men were part of a cohort of people receiving
the HIV prevention drug through the health programs. There were 485
people who started the drug between February 2011 and December 2014.

Hep C hadn’t been thought as sexually transmitted. But the study that
underscored that finding relied on heterosexual couples. Recent studies
have found probable sexual transmission of the virus — which attacks
the liver — in men who have sex with men in the U.S., Europe and
Australia.

Evidence of sexual acquisition of hepatitis C virus (HCV) among men who have sex with men (MSM) receiving pre-exposure prophylaxis through a San Francisco clinic has prompted a call for routine monitoring for the virus among PrEP users. In a letter to the editor in Clinical Infectious Diseases, clinicians from Kaiser Permanente San Francisco Medical Center describe new cases of hep C among two men out of 485 HIV-negative MSM receiving PrEP at the clinic between February 2011 and December 2014.

Considering the infections occurred during 304 person-years of follow-up, the hep C incidence rate was 0.7 per 100 person-years. This infection rate is lower than those observed among populations of HIV-positive MSM in published research. But the two cases add evidence to previous findings that the risk of sexual transmission of hep C is likely not reserved to those who are living with HIV. Additionally, however small the risk of hep C may be, its existence adds to the larger dialogue about having sex without a condom while on PrEP (or not on it, for that matter).

Evidence of sexual acquisition of hepatitis C virus (HCV) among men who
have sex with men (MSM) receiving pre-exposure prophylaxis through a San
Francisco clinic has prompted a call for routine monitoring for the
virus among PrEP users. In a letter to the editor in Clinical Infectious
Diseases, clinicians from Kaiser Permanente San Francisco Medical
Center describe new cases of hep C among two men out of 485 HIV-negative MSM receiving PrEP at the clinic between February 2011 and December 2014.

Considering
the infections occurred during 304 person-years of follow-up, the hep C
incidence rate was 0.7 per 100 person-years. This infection rate is
lower than those observed among populations of HIV-positive MSM in
published research. But the two cases add evidence to previous findings
that the risk of sexual transmission of hep C is likely not reserved to
those who are living with HIV. Additionally, however small the risk of
hep C may be, its existence adds to the larger dialogue about having sex
without a condom while on PrEP (or not on it, for that matter).

For more than a decade, an outbreak of hepatitis C virus has been
occurring among men who have sex with men (MSM) in Western Europe, North
America and Australia. Most of these men are HIV positive and HCV
appears to have been spread through sex. For details about how HCV is
spread, see this CATIE News story.

In 2009, researchers recruited 63 men between the ages of 35 and 47
years, all of whom were HIV positive but HCV negative. Most of the men
were taking potent combination anti-HIV therapy (commonly called ART or
HAART). Over a period of four years, the following events occurred.

Associate professor of hepatology Thomas Reiberger, MD, from the
University of Vienna, reviewed the findings of the Dutch scientists in
the journal Clinical Infectious Diseases. He noted that while
screening the blood samples of patients for HCV antibodies can be
useful, the findings from the Dutch work suggest that in some cases such
antibodies may not appear for several months after HCV infection has
occurred. In such cases, acute HCV infection might be missed if antibody
tests alone are used for screening. He agrees with the Dutch scientists
that RNA testing should be used to screen HCV infection.

HIV-negative men who have sex with men (MSM) are apparently at risk for
sexual acquisition of hepatitis C virus (HCV), the National AIDS
Treatment Advocacy Project reports. Their risk factors are likely
similar to those of HIV-positive men, among whom there is an emerging
epidemic of sexually transmitted hep C.

Researchers at Chelsea
and Westminster Hospital in London conducted a retrospective study of
the clinic’s patients in which they identified 44 acute cases of hep C
among HIV-negative MSM between January 2010 and December 2013.
Thirty-four percent of the men spontaneously cleared the virus, 25
percent began treatment for hep C, 30 percent remained in care and 11
percent were lost to follow-up. Then men’s ages ranged between 24 and
75, and the groups had a median age of 37.

The researchers concluded that “acute hepatitis C is a problem for
HIV-negative MSM who have similar risks [to HIV-positive MSM]. HCV
testing must be considered as a crucial part of sexual health screening
in environments where risk factors or outbreaks of HCV exist.”

Approximately 3.2 million individuals in the
United States are infected with chronic hepatitis C
(HCV) infection. While injection drug use is the
most common mode of transmission, growing
evidence indicates that the virus is also being
spread through sexual contact, particularly among
HIV-infected men who have sex with men (MSM).
If left untreated, HCV can lead to cirrhosis, endstage
liver disease, and death; HIV facilitates
the development of these complications. This
clinical brief reviews what is known about the
epidemiology of HCV among HIV-infected MSM,
as well as current screening, treatment,

Click here to access this new publication: Emerging Clinical Issue: Hepatitis C Infection in HIV-Infected Men Who Have Sex With Men and here for a list of other resources.

There have been many outbreaks of sexually acquired HCV among HIV
positive gay men and HIV positive men who have sex with men from every
corner of the globe. People who are HIV positive are at higher risk
for hepatitis C and should be tested for many reasons. One of the
most important reasons is because HCV disease progression is much
faster in those who are also infected with HIV. Another important
reason to test is that pre- and post-test counseling will help to
prevent the transmission of hepatitis C. There are already
recommendations that everyone with HIV should be tested for hepatitis
C, but maybe it’s time to expand the testing recommendations to
include all gay men and men who have sex with men. It could really
save many, many lives. -Alan Franciscus

————————————————————–

Despite newer and often highly effective treatments that are
essentially curative, not much has changed in terms of public awareness
and indifference. Hepatitis C remains a stealth disease. Public health
officials have long resisted the call to sound the alarm for hep C as an
STI (sexually transmitted infection), citing the weak transmissibility
of hep C sexually. For years, they didn’t even urge that the partners of
those who were hep C-positive be tested. Granted that HCV hasn’t shown
itself to be nearly as transmissible sexually as HIV, I expressed my
concerns about what seemed to be excessive cautiousness around testing
recommendations — in the gay press, for New York magazine as well as in a public health forum co-hosted by the CDC in Atlanta.1, 2
I argued that there needed to be greater awareness of and testing for
hepatitis C as an STI, especially among MSM. As the call-out in New York
put it, “Hepatitis C infections are spreading beyond high-risk groups,
causing a few physicians to call for widespread testing. But the medical
establishment is stalling. Sound familiar?”

Why was this so controversial? Why not just test everybody who might
be at risk, even if that risk were “small”? The reason I was given by
CDC epidemiologists and other public health officials was that urging
everyone to get tested for hep C, even all MSM, could create unwarranted
alarm and would be an unjustifiable expense in view of the relative
minority of cases. Also, despite the increasing numbers of cases in gay
men/MSM, those numbers remain “small,” and it wasn’t clear that other
undisclosed risk factors such as injection drug use weren’t responsible,
since increased rates of sexual spread weren’t being observed among
heterosexuals.

The study is aimed at assessing the safety and immunogenicity of HCV prime-boost vaccinations ChAd3-hliNSmut and MVA-hliNSmut, administered intramuscularly in healthy volunteers and DAA treated patients. To read the entire study, click here Share This PageFollow Us … Continue reading → The post The study is aimed at assessing the safety and immunogenicity of HCV […]

The purpose of this study is to evaluate the efficacy and tolerability of DAA-based regimens in the clinical practice in HIV/HCV-coinfected patients. Hypothesis: The efficacy and tolerability of all DAA-based regimens in the clinical practice is different to what is … Continue reading → The post Real-life Security and Efficacy of DAA-based Therapy in 1,000 […]